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CD90-positive stromal cells associate with inflammatory and fibrotic changes in modic changes

Stefan Dudli1,2, Agnieszka Karol3, Luca Giudici4

  • 1Center of Experimental Rheumatology, University Hospital Zurich, University of Zurich, Switzerland.

Osteoarthritis and Cartilage Open
|December 7, 2022
PubMed
Abstract

Insights

Modic changes (MC) involve vertebral bone marrow lesions associated with low back pain (LBP). This study found CD90-positive cells accumulate in MC, correlating with inflammation and fibrosis, suggesting a key role in LBP mechanisms.

Area of Science:

  • Spinal pathology
  • Bone marrow imaging
  • Histopathology

Background:

  • Modic changes (MC) are vertebral bone marrow lesions linked to disc degeneration and low back pain (LBP).
  • Previous studies qualitatively described MC histopathology, with limited patient samples.
  • CD90-positive bone marrow stromal cells have been implicated as pro-fibrotic in MC.

Purpose of the Study:

  • To conduct the first semi-quantitative histomorphometric analysis of bone marrow in Modic changes.
  • To investigate the potential role of CD90-positive cells in the pathomechanisms of Modic changes.

Main Methods:

  • Human vertebral bone marrow biopsies from Modic type 1 (MC1), Modic type 2 (MC2), and control (MC0) groups were analyzed.
  • Histology and immunohistochemistry were used to score inflammatory and fibrotic changes, and bone marrow stromal cell populations (CD90, CD105).
  • Statistical analyses including non-parametric tests, correlations, clustering, and principal component analysis were performed.

Main Results:

  • MC1 and MC2 showed significantly higher scores for CD90-positive cells compared to controls (MC0).
  • MC1 exhibited increased connective tissue, edema, and inflammatory infiltrates compared to MC0.
  • CD90 scores strongly correlated with inflammatory and fibrotic markers, and connective tissue amount correlated with LBP severity.

Conclusions:

  • CD90-positive cell accumulation is a key feature of Modic changes in patients undergoing spinal fusion.
  • These cells are associated with inflammatory and fibrotic changes within the bone marrow.
  • CD90-positive cells likely play a significant role in the inflammatory-fibrotic processes underlying Modic changes and LBP.
Keywords:
Bone marrow oedemaFibrosisInflammationLow back painModic changes

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